Meeran’s Mock Flashcards
post thyroidectomy has tingling
which electrolyte to measure?
CALCIUM
why does postthyroidectomy pt have tingling ?
iatrogenic removal of parathyroid too, resulting in low Calcium
what marker is raised in Pagets
ALP
why does pagets have a raised ALP
increased osteoclast and blast activity
Ix of Pagets
technetium 99 bisphosphonate bone scan
what does technetium 99 bisphosphonate bone scan show
uptake by bones with high osteoblast activity
what would a plain XR show in pagets
fractures
what type of hearing damage does Pagets cause
conductive and sensorineural
why does Pagets cause conductive and sensorineural hearing loss
conductive - ossicles damage
sensorineural - presses on CN8
what marker is raised in osteomalacia
ALP
why is ALP raised in osteomalacia
increased bone turnover
high ALP
slightly low Calcium
what causes osteomalacia
low vitamin D (secondary hyperparathyroidism)
what markers are raised after an MI
AST
troponins
CK
LDH
why is AST increased after an MI
AST is found outside the liver too, including in the heart
electrolytes in Addisons
high K
low Na
what marker is raised in jaundice caused by gallstones
ALP
what is the portal triad
bile duct
portal vein
hepatic artery
is the blood in central vein ‘clean’ or ‘dirty’ and why
clean - its been through the hepatocytes before entering central vein
what marker is raised in obstructive jaundice & why
ALP - found near portal triad
what marker is raised in alcoholism and why
AST - found near central vein
what marker is raised in jaundice caused by viral hepatitis
ALT»_space; AST
why does ALT rise after viral hepatitis
inflamed hepatocytes
what marker is raised in jaundice caused by chronic alcoholic cirrhosis
AST
why is AST released the most after alcoholic cirrhosis
liver architecture is destroyed by mast cell death –> nodules produced –> release AST
what marker is raised in prostatic carcinoma (another name for PSA)
acid phosphatase
Calcium, vitamin D and ALP levels in primary hyperparathyroidism
high Ca
low vitamin D - gets consumed quickly
high ALP
what marker is raised in dehydration causing AKI
urea
if GFR falls in CKD, what will happen to the creatinine
increase
what is the marker of GFR
creatinine
how does the reactivity of urea differ in CKD vs normal person
less reactive in CKD
what is the marker of glucose control over the last 3 months
HbA1c
what is the marker of glucose control over the last 3 weeks
fructosamine
what is fructosamine used for and why
protein with shorter half life than RBC, so better for frequent glucose monitoring
30M polyuria nad polydipsia. High Ca, normal PTH, low PO43-. Dx?
primary hyperparathyroidism
what is primary hyperparathyroidism
inappropriately normal PTH in the presence of high calcium
50F Asian woman with tingling. carpal spasm on BP check. low Ca, very high PTH. Dx?
secondary hyperparathyroidism
what is secondary hyperparathyroidism caused by
chronic low vit D
what is secondary hyperparathyroidism aka
osteomalacia
50F asian woman with nocturne and dizziness. low blood glucose, high calcium, normal PTH, low Na and high K. Dx?
Addisons
60M knee pain. aspiration of joint = positively birefringent crystals. Dx?
pseudo gout
what is lesch-nyan syndrome
uric acid metabolism issue, causing you to get gout
30M polyuria and polydipsia. High Na, everything else normal. Dx?
Diabetes insipidus (vasopressin deficiency)
30M jaundice, conjunctival haemorrhages. Been canoeing in the US. Dx?
Leptospirosis
what is a rodent ulcer aka
basal cell carcinoma
what organ is this from
thyroid
- thyroglobulin surrounded by follicular cells
what organ is this from
liver
- portal triad and central vein with dense hepatocytes in-between
what organ is this from
kidney
- glomeruli (big round things) with tubules near
what organ is this from
adrenal
- dense, smooth edge is zona glomerulosa. paler central area is medulla.
high urinary sodium osmolality, low blood sodium osmolality. Dx?
SIADH
what causes the high urinary and low blood sodium zinc in SIADH
reabsorbing lots of water therefore urine very concentrated and blood very dilute
if the blood osmolality is low, what should the urine osmolality be?
VERY low - pee out all the dilute urine to get rid of water
25F hits head then gets very thirsty with nocturia. Low blood sodium osmolality. Dx?
psychogenic polydipsia
25F hits head then gets very thirsty with nocturia. Low blood sodium osmolality. why can’t this be DI?
DI is deficiency of vasopressin, causing no water to be reabsorbed therefore Na would be really HIGH
40M HTN. Low K, high renin, high aldosterone. Dx?
renal artery stenosis
40M HTN. Low K, high renin, high aldosterone. why is this renal artery stenosis?
high renin ! also highaldosterone
causes of renal artery stenosis in kids vs elders
kids = fibromuscular
elderly = cholesterol
40M HTN. Low K, low renin, high aldosterone. Dx?
Conn’s syndrome
40M HTN. Low K, low renin, high aldosterone. why is this conns?
suppressed renin !
tired pt has low Na, high K, low glucose. Dx?
Addisons
ACEi in DM pts - what is their effect on creatinine?
worsens creatinine within days of starting
ACEi in DM pts - what is their benefit?
prevents end stage renal failure
what causes increased creatinine with ACEi in DM pts
ACEi reduce A2 and aldosterone, but also reduced glomerular pressure. this reduces albuminuria, which increases creatinine
what other drug class has a similar effect on the kidneys as ACEi in DM pts
SGLT2i
when should ACEi be stopped in DM pts temporarily and why
sepsis and pneumonia
need the GFR back
what kidney condition is an absolute CI to ACEi and why
renal artery stenosis
- causes GFR to fall to 0 and pt will die
Tx of choice for albuminuria in DM pt
ACEi
what needs to be checked a few days after starting ACEi in DM pts and why
GFR - to check if there was any underlying renal artery stenosis that could cause GFR to fall to 0 and kill pt
deadly strain of malaria causing organ damage due to impaired microcirculation
plasmodium falciparum
malaria strain that need primaquine 30mg to eradicate liver paras
plasmodium vivax
test to determine species of malaria parasite
THIN film
what is the thick film test for malaria actually for
to detect any malaria there at all
45F itchy skin, raised ALP and AMA+. Dx?
PBC
15M liver disease and Kayser Fleischer rings. Dx?
Wilsons
pt visited India, now has fever, jaundice and malaise. Raised ALT. Dx?
Hep A
45M. High BR, high PTT, low albumin, folate and B12. Leucocytosis. Dx?
alcoholic liver disease
- albumin is low therefore chronic
45F with UC has jaundice etc. ERCP = beaded appearance. Raised ALP and BR. Hypergammaglobulinaemia. Dx?
PSC
